Abdo

Question 1

what are you looking for in hands, in abdo exam

Answer 1

clubbing
leukonykia 
koilonykia  
palmar erythema 
Dupuyten contractures

Question 2

causes of clubbing

Answer 2

GI:

• IBD
• Coeliac
• Cirrhosis
• Malignancy

Respiratory:

• malignancy
• cystic fibrosis
• bronchiectasis
• empyema (pus in chest)

Question 3

How does clubbing present

Answer 3

inreased curvature of the nail, causing loss of Shamross window

Question 4

what does palmar erythema indicate

Answer 4

CLD

Question 5

what do dypuytrens indicate

Answer 5

cirrhosis

Question 6

what does asterixis indicatew

Answer 6

Hepatic encepalopathy (due to toxin ammonia buildum) 
or CO2 retention

Question 7

splenomegaly causes

Answer 7

Infection - TB, malaria, leishmaniasis
Inflammation: Portal HTN, Infiltrative - sarcoid, gaucher
Haem - myelofibrosis, chronic myeloma

Question 8

causes of enlarged kidney

Answer 8

PKD
simple cyst
renal tumour
infiltrative (sarcoid, TB)

Question 9

hepatomegaly causes

Answer 9

HEART: RHF

HEPATIC: Infection, inflammation and malignaancy

INFECTION:

• Hep B,C
• EBV, CMV

Inflammation:

• ALD, AI, NASH
• Amyloidosis
• Sarcoidosis
• Haemochomatosis

Malignancy:

• primary liver cancer
• metastatic liver
• lymphoma, leukaemia

Question 10

how do you differentiate between kidney and spleen

Answer 10

spleen moves down with inspiration
cannot get above the spleen
spleen has a splenic notch
spleen is dull to percussion (kidneys are resonant)

KIDNEYS ARE BALLOTABLE

Question 11

signs of CO2 retention

Answer 11

Asterixis (flapping tremor - due to brain irritation)
Bounding pulse 
Vasodilation
papilledema 
mental changes 
drowsiness

Question 12

whatc causes leukonychia + presentation

Answer 12

hypoalbuminaemia (due to white spots on nails)

Question 13

what causes koilonychia

Answer 13

iron deficiency anaemia (spoon nails)

Question 14

what are you looking foor in the arms

Answer 14

tattoos / needle marks
petechiae / bruising
fistulae from renal haemodyalisis

Question 15

what are you looking for in the eyes

Answer 15

conjunctival pallor (eyelid down)
scleral icterus (eyelid up)
kaiser fleisher rings
xanthalasma (PBC)

Question 16

what are you looking for in the mouth

Answer 16

angular stomatitis (inflammation) 
aphtous ulcers in mouth 
atrophic glossitis (IDA) 
macroglossia (B12/folate deficiency)

Question 17

what do you inspect for on abdomen when lying the bed flat

Answer 17

scars
distension (mass/ascites/splenomeg) 
caput medusa 
Cullens/grey turners 
stomas

Question 18

what are spider naevi, what can cause them

Answer 18

blanching telangectasing arteriole

• cirrhosis
• high levels of oestrogen

Question 19

what is cullens sign and what can cause it

Answer 19

CULLEN’s = PERIUMBLICAL (acute pancreatitis, abdominal trauma, aortic rupture, ectopic pregnancy rupture)

Question 20

what is grey turners and what can cause it

Answer 20

bleeding from the flanks (RETROPERITONEAL)

acute pancreatitis

Question 21

causes of hepatosplenomegaly

Answer 21

chronic liver disease with portal hypertension
hematological disease, e.g. myeloproliferative disease, lymphoma, leukemia, pernicious anemia, sickle cell disease
infection, e.g. viral hepatitis, EBV, CMV
infiltration, e.g. amyloidosis, sarcoidosis
Connective tissue disorders e.g. SLE
acromegaly
thyrotoxicosis